Σταδιοποίηση σε Ca Χοληδόχου Κύστεως

Ca Χοληδόχου Κύστης

AJCC Stages

Stages

T

N

M

0

Tis

N0

M0

I

T1

N0

M0

II

T2

N0

M0

IIIA

T3

N0

M0

IIIB

T1, T2, T3

N1

M0

IVA

T4

N0, N1

M0

IVB

Any T

N2

M0

Any T

Any N

M1

(T) Primary Tumor

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

Tis

Carcinoma in situ

T1

Tumor invades lamina propria or muscular layer

T1a

Tumor invades lamina propria

T1b

Tumor invades muscular layer

T2

Tumor invades the perimuscular connective tissue; no extension beyond the serosa or into liver

T3

Tumor perforates the serosa (visceral peritoneum) &/or directly invades the liver &/or 1 other adjacent organ or structure, such as the stomach, duodenum, colon, pancreas, omentum, or extrahepatic bile ducts

T4

Tumor invades main portal vein or hepatic artery or invades ≥ 2 extrahepatic organs or structures

(N) Regional Lymph Nodes

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Metastases in nodes along the cystic duct, common bile duct, hepatic artery, &/or portal vein

N2

Metastases to periaortic, pericaval, superior mesenteric artery, &/or celiac artery lymph nodes

(M) Distant Metastasis

M0

No distant metastasis

M1

Distant metastasis

Χαρακτηριστικά Επέκτασης

Direct spread

• Direct spread is common and occurs early
  • Due to lack of muscularis mucosa and submucosa in gallbladder wall
• Tumor can spread to following organs
  • Liver
    • In autopsy series, direct extension to liver was present in up to 65% of cases
    • Facilitated by direct venous drainage through liver parenchyma to hepatic veins
    • Gallbladder straddles Couinaud segments 4b and 5, which are segments initially invaded by carcinoma
  • Colon (15%)
  • Duodenum (15%)
  • Pancreas (6%)

Lymphatic spread

• Present in > 50% of patients at initial diagnosis
• Frequency of involvement of lymph nodes is strongly influenced by depth of invasion of primary tumor
• Regional nodes are those along cystic duct, common bile duct, hepatic artery, and portal vein (N1)
• Periaortic, pericaval, superior mesenteric, and celiac artery nodes are considered N2
• More distal nodal metastases are considered M1

Intraductal spread

• Tumor extending to cystic duct is indication of poor prognosis
• Carcinoma of gallbladder neck region frequently involves common bile duct
  • By intraductal extension through cystic duct or by external invasion of hepatoduodenal ligament
• Results in obstructive jaundice

Hematogenous spread

• Mainly to liver
  • Hepatic metastatic nodules, away from primary tumor, indicate dismal outcome even after resection
• Other organs affected include lungs and bones
  • Rare at presentation
  • Usually occur in patients with advanced local disease

Neural pathways

• Perineural invasion more common in patients with extrahepatic bile duct invasion
  • 96% of patients with extrahepatic bile duct invasion have perineural invasion
  • Worse prognosis than in patients without perineural invasion

Intraperitoneal "drop" metastases

• Occur after tumor breaks serosal coverage
• Peritoneal seeding occurs → peritoneal metastases

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

• Carcinoma in situ
• Adenocarcinoma, not otherwise specified (NOS) (75.8%)
• Carcinoma, NOS (7.6%)
• Papillary carcinoma (5.8%)
• Mucinous carcinoma (4.8%)
• Adenosquamous carcinoma (3.6%)
• Squamous carcinoma (1.7%)

• Small cell (oat cell) carcinoma (0.5%)
• Adenocarcinoma, intestinal type
• Clear cell adenocarcinoma
• Signet ring cell carcinoma
• Undifferentiated carcinoma
  • Spindle and giant cell types
  • Small cell types
• Carcinosarcoma